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The short-term adverse effects of ambient fine particulate matter (PM 2.5) and ozone (O 3) on anxiety disorders (ADs) remained inconclusive. We applied an individual-level time-stratified case-crossover study, which including 126,112 outpatient visits for ADs during 2019–2021 in Guangdong province, China, to investigate the association of short-term exposure to PM 2.5 and O 3 with outpatient visits for ADs, and estimate excess outpatient visits in South China. Daily residential air pollutant exposure assessments were performed by extracting grid data (spatial resolution: 1 km × 1 km) from validated datasets. We employed the conditional logistic regression model to quantify the associations and excess outpatient visits. The results of the single-pollutant models showed that each 10 μg/m3 increase of PM 2.5 and O 3 exposures was significantly associated with a 3.14 % (95 % confidence interval: 2.47 %, 3.81 %) and 0.88 % (0.49 %, 1.26 %) increase in odds of outpatient visits for ADs, respectively. These associations remained robust in 2-pollutant models. The proportion of outpatient visits attributable to PM 2.5 and O 3 exposures was up to 7.20 % and 8.93 %, respectively. Older adults appeared to be more susceptible to PM 2.5 exposure, especially in cool season, and subjects with recurrent outpatient visits were more susceptible to O 3 exposure. As our study subjects were from one single hospital in China, it should be cautious when generalizing our findings to other regions. Short-term exposure to ambient PM 2.5 and O 3 was significantly associated with a higher odds of outpatient visits for ADs, which can contribute to considerable excess outpatient visits. • Exposure to ambient PM 2.5 and O 3 was associated with an increased odds of outpatient visits for anxiety disorders. • PM 2.5 and O 3 exposures were attributable to considerable excess outpatient visits. • Older adults were more susceptible to PM 2.5 exposure, especially in cool season. • Subjects with recurrent outpatient visits were more susceptible to O 3 exposure. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) is a chronic disease with an increasing prevalence on a global scale, including in Indonesia. Based on the International Diabetes Federation (IDF) data, Indonesia ranks fifth in the world in terms of the number of people living with diabetes. In 2021, there were an estimated 19.5 million individuals with diabetes in Indonesia, a figure that is predicted to reach 28.6 million by 2045. Additionally, Indonesia is ranked third in the world for the highest number of undiagnosed cases and sixth for the highest number of deaths related to diabetes globally in 2021. However, it is important to note that Indonesia has a robust primary healthcare system, including the JKN program and the promotion of preventive measures regularly implemented at the primary care level. One of the initiatives designed to enhance the quality of life of individuals with diabetes is the Chronic Disease Management Program (Prolanis). Method: A cross-sectional study explored the relationship between the Diabetes Mellitus Chronic Disease Management Program (Prolanis) and outpatient visits for patients with diabetes mellitus at Class C Palembang Hospitals in 2023. The research utilised secondary data derived from various sources, including 5168 health service data of BPJS Kesehatan, previous research, scientific studies, and the interrelationship between eight independent variables. It was then evaluated using the correlation analysis method and multiple logistic regression. Result and Discussion: The results of the study demonstrate a notable correlation between participation in the JKN program pvalue=0.000 < 0.05, utilization of primary healthcare services pvalue=0.000 < 0.05, HbA1C 0.000<0.005 and engagement in physical activity pvalue=0.009 < 0.05 with the Prolanis DM program and outpatient visits for individuals with diabetes at the Class C Palembang Hospitals in 2023. Conclusion: A reduction in the number of outpatient visits was observed among DM sufferers who participated in the Prolanis program actively participate that influenced JKN membership, health facility, HbA1C result and education physical activity. [ABSTRACT FROM AUTHOR]

BackgroundNitrogen dioxide (NO2), a crucial component of traffic pollutants, has been shown in studies to exert toxic effects on the nervous system. However, there is a limited body of research examining the relationship between NO2 exposure and neurological disorders in children. ObjectiveTo explore the impact of short-term NO2 exposure on the outpatient visits due to pediatric neurological diseases in Shijiazhuang. MethodsFrom 2013 to 2021, we collected outpatient data related to neurological diseases at the Children's Hospital in Shijiazhuang, Hebei Province. We also collected air pollution data and meteorological data of the same city. The air pollution data included daily average concentrations of inhalable particles (PM10), fine particulate matter (PM2.5), sulfur dioxide (SO2), NO2, carbon monoxide (CO), and daily maximum 8-hour average concentration of ozone (O3). The meteorological data comprised daily average atmospheric pressure, temperature, relative humidity, wind speed, and sunshine duration. Employing a time-stratified case-crossover design, we used conditional logistic regression models to analyze the association between NO2 and pediatric outpatient visits for neurological diseases. Stratification analyses were conducted based on gender (male, female) and age groups (0-6 years, 7-14 years). ResultsThe study included a total of 154348 valid pediatric outpatient visits for neurological diseases. The daily average concentration of NO2 was 49.3 μg·m−3 for the study period. The results from the single-pollutant model indicated that NO2 increased the risk of pediatric neurological outpatient visits, with the highest association observed at lag0. Specifically, for every 10 μg·m⁻³ increase in atmospheric NO2 exposure, there was a 1.40% increase (95%CI: 1.05%, 1.74%) in pediatric neurological outpatient visits. The stratification analyses revealed that increased atmospheric NO2 exposure was associated with an elevated risk of neurological outpatient visits for girls (ER=1.54, 95%CI: 1.01, 2.08) and children aged 7-14 years (ER=2.35, 95%CI: 1.68, 3.02). Even after introducing PM2.5 (ER=1.96, 95%CI: 1.49, 2.43), SO2 (ER=2.09, 95%CI: 1.62, 2.55), and O3 (ER=1.40, 95%CI: 1.06, 1.74) to the models, the impact of NO2 exposure on pediatric neurological outpatient visits remained statistically significant. The results of the multi-pollutant model also indicated a significant association (ER=2.53, 95%CI: 1.97, 3.08). ConclusionThe effect of short-term exposure to atmospheric NO2 on the outpatient visits of children with neurological diseases in Shijiazhuang is acute and independent, especially for children aged 7-14.

At present, evidence of the associations between carbon monoxide (CO) and respiratory diseases (RD) in Northwest China is limited and controversial. The aim of this study is to evaluate the impact of ambient CO on outpatient visits for RD in Lanzhou, China. The daily amount of outpatient visits for total and cause-specific RD, air pollutant, and weather variables were collected in Lanzhou, China from 1st January 2013 to 31st December 2019. A generalized additive model and distributed lag nonlinear model were used to assess associations between CO and outpatient visits for RD. During the study period, a total of 1,623,361 RD outpatient visits were recorded. For each interquartile range (IQR) (0.77 mg/m3) increase in CO, the relative risk (RR) was 1.163 (95% CI: 1.138, 1.188) for total RD at lag07, 1.153 (95% CI: 1.128,1.179) for upper respiratory tract infection (URTI) at lag07, 1.379 (95% CI: 1.338,1.422) for pneumonia at lag07, 1.029 (95% CI: 0.997,1.062) for chronic obstructive pulmonary disease (COPD) lag04, 1.068 (95% CI: 1.028,1.110) for asthma lag03, and 1.212 (95% CI: 1.178,1.247) for bronchitis lag07, respectively. In the subgroup analyses, the impacts of CO were more pronounced on total RD, pneumonia, COPD, and bronchitis in males than females, while the opposite was true in URTI and asthma. The impact of CO on RD was the strongest for children under 15 years-of-age. We also found significantly stronger effects during cold seasons compared to warm seasons. In addition, we observed a roughly linear exposure–response curve between CO and RD with no threshold effect. This study in Lanzhou revealed a remarkable association between CO level and an elevated risk of total and cause-specific RD outpatient visits, especially for pneumonia. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore the association between air pollutants and hospital outpatient visits in a district of Shanghai.MethodsDaily meteorological data， environmental data， data of outpatient visits to two secondary hospitals and two tertiary hospitals in this district from January 1， 2015 to December 31， 2019 were collected. A Poisson regression generalized linear model was used to analyze the exposure-response relationship between the air pollutants and hospital outpatient visits in this area.ResultsDuring the study period， the total number of outpatient visits in the included hospitals was 17 802 634， with an average daily total of （9 750±4 191） outpatient visits，and an average daily of （761±341） respiratory outpatient visits. In the lag effect of single pollutant model， when the concentration of air pollutant increased by 10 μg·m-3， PM2.5， SO2， NO2 had the maximum lag effect on the number of outpatient visits in the department of internal medicine for respiratory diseases on lag day 4， day 5 and day 7， respectively. And the RR values and 95%CI were 1.002 0（1.001 3‒1.002 6）， 1.0154（1.012 3‒1.018 5）， and 1.006 1（1.005 3‒1.006 9）， respectively.ConclusionThere is a exposure-response relationship between air pollutants and the number of outpatient visits in each department of the hospitals， and different pollutants have different degrees of lag effects.

ObjectiveTo analyze the effect of O3 pollution on outpatient visits for respiratory diseases in a district of Shanghai.MethodsWe collected the respiratory disease outpatient data， and atmospheric and meteorological data of from a suburban general hospital in Shanghai from 2015 to 2017. A time-series analysis by generalized additive model was conducted to examine the relationship between O3 pollution and daily outpatient visits.ResultsThe daily outpatient volume for respiratory diseases was 831. The daily 8 h median concentration of O3 was 101.04 μg·m-3. The excess relative risk was 0.461% （95%CI： 0.240%‒0.682%） at lag3. Stratified by gender and age， females， child and the aged had higher risk of respiratory diseases. In the double-pollutant model， PM2.5 and PM10 increased health effects， while CO reduced health effects.ConclusionThe increase of O3 concentration can increase the daily outpatient volume of respiratory diseases.

Aim: to compare the efficacy of different therapeutic regimens for managing functional dyspepsia in outpatients after COVID-19 infection.Materials and methods. 42 post-COVID-19 outpatients (age: 26–47 years) diagnosed with functional dyspepsia (FD) according to the Rome IV Criteria were enrolled in two parallel groups. All patients were divided in 2 groups by randomization: Group 1 received omeprazole at a dose of 80 mg/day, Group 2 received a combination of omeprazole and Kolofort® (a combined action drug product containing technologically processed antibodies to S100, TNF-alpha, and histamine) at a dose of 80 mg/day. At baseline and after treatment, a 10-point VAS was used to measure symptoms and an SF-36 questionnaire to evaluate the quality of life.Results. By Day 28 of the treatment, the intensity of epigastric pain (VAS score) in the group receiving proton-pump inhibitor (PPI) + Kolofort® was significantly lower. In both groups, fully resolved dyspeptic syndrome was observed in up to 90 % of patients, without significant differences (p < 0.06). According to the SF-36 data, a combination treatment resulted in higher scores (pain and general health subscales) as compared to the PPI alone.Conclusion. Kolofort® relieves symptoms and improves the quality of life when added to the treatment regimen against functional dyspepsia in post-COVID-19 patients.

Background: Goal directed point of care ultrasound (POCUS) is a bedside tool to assist with clinical diagnosis. We examined the impact of POCUS performed by consulting cardiologist (CC) during initial cardiology consult on clinical management and downstream testing. Methods: Sixty‐nine study patients (pts) seen in a general cardiology outpatient clinic of a tertiary center by an expert imaging CC were compared to a control group of 65 pts seen by three different CCs without POCUS during the same time‐period, in whom the first standard echo (SE) was performed after the initial visit. Results: Baseline characteristics were similar between the two groups for age, cardiac risk factors, and referral diagnoses. Echo findings on POCUS and by SE (mean delay of 17.2 days after visit) in the control group were comparable for RV size and function and for valvular heart disease. More patients with lower LVEF, higher LV filling pressures, new regional wall motion abnormalities, and increased aortic root size were present among POCUS group resulting in greater yield of echo abnormalities. There were more cardiovascular medication changes at the first visit (15.3% vs. 5.7%, p <.01), less referral for noninvasive stress testing (10% vs. 29%, p <.01), more advanced cardiac testing and subspecialty referrals (29% vs. 18% pts, p =.06), in the study compared to the control group after cardiology visit. Conclusion: POCUS at time of consultation detects more abnormal echo findings, results in more medication adjustments, less referral for noninvasive stress testing, earlier referral for advanced cardiac diagnostic imaging, and subspecialty cardiac referrals. [ABSTRACT FROM AUTHOR]

Abstract Background With an increase in the aging population, the number of older adults who require long-term care (LTC) is growing, enhancing drug-related issues. The reduced capacity of LTC users to precisely utilize medical services poses additional challenges owing to restrictions in daily activities. We compared older adults who required LTC with those who did not require LTC to confirm differences in the use of potentially inappropriate medications (PIMs), frequently used PIMs, and associating factors in Korea. Methods Using the Korean National Health Insurance Service cohort data, adults aged ≥ 65 years as of 2017 who were LTC beneficiaries (at home and LTC facilities) were selected and matched 1:1 with a control group (LTC non-beneficiaries). PIM was defined based on the 2019 American Society of Geriatrics Beers criteria. PIM use and medical resource utilization according to LTC requirements were compared for one year after the index date. After correcting for other confounding variables, differences in the risk of PIM use on person-based according to LTC eligibility were assessed using multivariate logistic regression. Results Among the 13,251 older adults requiring LTC in 2017, 9682 were matched with counterparts and included. Among those who received an outpatient prescription including PIM at least once yearly, 83.6 and 87.6% were LTC beneficiaries and LTC non-beneficiaries, respectively (p

Blepharitis is a very common ophthalmologic disease, and few studies have examined if air pollutants contribute to the risk of blepharitis. We investigated the presence of any potential correlation between exposure to air pollution and outpatient admission for blepharitis in Shanghai, China. Data on daily outpatient admission for blepharitis were collected from January 2017 to July 2022. Air pollution and meteorological data were acquired from the Shanghai Environmental Protection Agency. Using the distributed lag non-linear model (DLNM) we investigated the relationship between air pollutants and blepharitis. Seasonal stratified analysis was carried out. In total, 10,681 blepharitis patients were recruited. In the single-pollutant model, a 10 μg/m3 increase in particulate matter with < 2.5 μm PM2.5 and 10 μm PM10 along with sulfur dioxide (SO2) and 100 μg/m3 increase in carbon monoxide (CO) was significantly associated with outpatient visits for blepharitis. In the multi-pollutant model, a 10 μg/m3 increase in ozone (O3) and nitrogen dioxide (NO2) and a 100 μg/m3 increase in carbon monoxide (CO) was significantly associated with outpatient visits for blepharitis. Moreover, there was an obvious relationship between blepharitis and PM2.5 and O3 in the summers and blepharitis and PM10, NO2, and SO2 during the winters. Exposure to short-term air pollution increases the risk of blepharitis outpatient visits in Shanghai, China. [ABSTRACT FROM AUTHOR]

This time-stratified case-crossover study aims to quantify the risk of allergic conjunctivitis (AC) associated with short-term exposure to PMs (i.e., PM1, PM2.5, PMc, and PM10) among children in Guangzhou, China. We collected data on children's daily AC outpatient visits from the Guangzhou Women and Children Medical Center during February 20, 2016 to December 31, 2018, and also extracted air pollution and meteorological data in the same time frame. We used conditional logistic regression model to estimate the associations between PMs and AC outpatient visits, and conducted subgroup analyses stratified by sex, age, and season. During the study period, we recorded 39,330 children's outpatient visits for AC, including 27,638 boys and 11,692 girls. The associations between PMs and AC were general linear with no clear threshold, which were largest at the current days but remained positive for lag 1 to 3 days. For every 10 μg/m3 increase in daily PM1, PM2.5, PMc, and PM10 concentrations, the estimated risks of AC outpatient visits at the current days increased by 2.5% (OR = 1.025, 95% CI: 1.011–1.039), 1.8% (OR = 1.018, 95% CI: 1.009–1.027), 2.1% (OR = 1.021, 95% CI: 1.004–1.039), and 1.3% (OR = 1.013, 95% CI: 1.007–1.020), respectively. In addition, our stratified analyses revealed that girls and children aged 1 to 6 years were more sensitive to PM exposure, and the PM-associated risks for AC were more apparent in autumn and winter. Our study suggests that short-term exposure to PMs may induce AC in children. [ABSTRACT FROM AUTHOR]

BackgroundAir quality health index (AQHI) has been widely used to quantify the health effects of multiple pollutants observed in population-based epidemiological studies, and can better reflect the widespread linear non-threshold between air pollution and health effects.ObjectiveTo explore an AQHI for pediatric respiratory diseases (AQHIr) in Shanghai and evaluate its feasibility.MethodsThe daily numbers of hospital outpatient visits for pediatric respiratory diseases from 2015 to 2019 were obtained from five general hospitals in Xuhui, Baoshan, Hongkou, Jinshan, and Chongming Districts of Shanghai. Monitoring data on air pollutants (PM2.5, PM10, SO2, NO2, and O3), air quality index (AQI), and meteorological variables (temperature, relative humidity, air pressure, and wind speed) were collected from five air quality monitoring sites nearest to selected hospitals. Time-series analysis using generalized additive model (GAM) was conducted to estimate the associations between respiratory-related pediatric outpatient visits and the concentrations of air pollutants. The sum of excess risk (ER) of hospital outpatient visits was used to construct AQHIr. To assess the predictive power of AQHIr, the associations of AQHIr and AQI with the number of pediatric respiratory outpatient visits in three hospitals in Xuhui, Hongkou, and Chongming districts were compared.ResultsAir pollutants had various effects on respiratory diseases outpatient visits. PM2.5, NO2, and O3 had most significant impacts on lag0 day and the associated ERs of hospital outpatient visits for each 10 μg·m−3 increase in pollutant concentration were 1.27% (95%CI: 0.88%-1.66%), 0.75% (95%CI: 0.40%-1.11%), and 0.36% (95%CI: 0.10%-0.62%), respectively. PM10 and SO2 had most significant impacts on lag3 day and the associated ERs of hospital outpatient visits for each 10 μg·m−3 increase in pollutant concentration were 0.81% (95%CI: 0.51%-1.12%) and 5.64% (95%CI: 3.37%-7.96%), respectively. There were significant effects of combinations of two pollutants among PM2.5, PM10, NO2, SO2, and O3 except for PM10+NO2, SO2+PM2.5, and SO2+NO2 (P

Helicobacter pylori infection (HPI) is an important risk factor of gastrointestinal diseases, but factors leading to it are still not fully understood. To investigate the association between short-term exposure to air pollution and HPI during outpatient visits, we collected daily data for HPI outpatient visits and air pollutant concentrations during 2014–2021 in Hefei, Anhui Province, China. A time-stratified case-crossover design was performed to analyze the acute impacts of air pollution on HPI outpatient visits. We also explored potential effect modifiers. A total of 9072 outpatient visits were recorded. We found positive and statistically significant associations of acute exposure to nitrogen dioxide (NO2), sulfur dioxide (SO2), and carbon monoxide (CO) with HPI outpatient visits. Threshold concentrations of the three pollutants with same-day exposure (lag 0 day) for outpatient visits were 37 μg/m3 for NO2, 8 μg/m3 for SO2, and 0.8 mg/m3 for CO. The odds ratios for HPI outpatient visits at the 95th percentile of NO2, SO2, and CO against the thresholds were 1.207 (1.120–1.302), 1.175 (1.052–1.312), and 1.110 (1.019–1.209), respectively. The associations were more evident in patients older than 45 years, females, with health insurance, and in cold seasons. Null associations of exposure to either ozone (O3) or particulate matter (PM) were observed. In summary, short-term exposure to NO2, SO2, and CO above certain concentrations, but not PM or O3, may trigger the increased risk of outpatient visits due to HP infection in Chinese population. [ABSTRACT FROM AUTHOR]

Background: With an increase in the aging population, the number of older adults who require long-term care (LTC) is growing, enhancing drug-related issues. The reduced capacity of LTC users to precisely utilize medical services poses additional challenges owing to restrictions in daily activities. We compared older adults who required LTC with those who did not require LTC to confirm differences in the use of potentially inappropriate medications (PIMs), frequently used PIMs, and associating factors in Korea. Methods: Using the Korean National Health Insurance Service cohort data, adults aged ≥ 65 years as of 2017 who were LTC beneficiaries (at home and LTC facilities) were selected and matched 1:1 with a control group (LTC non-beneficiaries). PIM was defined based on the 2019 American Society of Geriatrics Beers criteria. PIM use and medical resource utilization according to LTC requirements were compared for one year after the index date. After correcting for other confounding variables, differences in the risk of PIM use on person-based according to LTC eligibility were assessed using multivariate logistic regression. Results: Among the 13,251 older adults requiring LTC in 2017, 9682 were matched with counterparts and included. Among those who received an outpatient prescription including PIM at least once yearly, 83.6 and 87.6% were LTC beneficiaries and LTC non-beneficiaries, respectively (p < 0.001). Using the number of outpatient prescriptions as the baseline, 37.2 and 33.2% were LTC beneficiaries and LTC non-beneficiaries, respectively (p < 0.001). In both groups, elevated PIM use depended on increased medical resource utilization, as shown by increased outpatient visits and medical care institutions visited. Adjusting other influencing factors, the need for LTC did not significantly associated with PIM use (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.84–1.04); the number of drugs consumed (3–4: OR 1.42, 95% CI 1.25–1.61; 5–9: OR 2.24, 95% CI 1.98–2.53; 10 and more: OR 3.72, 95% CI 3.03–4.55; reference group: 2 and less), frequency of visits (7–15: OR 1.95, 95% CI 1.71–2.23; 16–26: OR 3.51, 95% CI 3.02–4.07; 27–42: OR 5.84, 95% CI 4.84–7.05; 43 and more: OR 10.30, 95% CI 8.15–13.01; reference group: 6 and less), and visits to multiple medical care institutions (3–4: OR 1.96, 95% CI 1.76–2.19; 5 and more: OR 3.21, 95% CI 2.76–3.73; reference group: 2 and less) emerged as primary influencing factors. PIMs mainly prescribed included first-generation antihistamines, benzodiazepines, and Z-drugs in both groups; quetiapine ranked second-highest among LTC beneficiaries. Conclusions: The LTC demand did not significantly associated with PIM utilization. However, the number of drugs consumed, and the pattern of medical resource use were important factors, regardless of LTC requirements. This highlights the need to implement comprehensive drug management focusing on patients receiving polypharmacy and visiting multiple care institutions, regardless of LTC needs. [ABSTRACT FROM AUTHOR]

Short-term exposure to ozone has been linked to multiple allergic diseases, but the relationship between ozone exposure and allergic conjunctivitis (AC) remains unclear. This study aimed to investigate the association between short-term exposure to ozone and the risk of AC. We conducted a time-stratified case-crossover study across five Chinese cities from 2014 to 2022. Daily outpatient visit records for AC were identified in five hospitals using either the diagnosis name or ICD-10 code H10.1. Data on air pollution and meteorological conditions were also collected. We first examined the city-specific association between short-term ozone exposure and AC using conditional logistic regression. A random-effects meta-analysis was then conducted to obtain overall estimates. During the study period, 130,093 outpatient visits for AC occurred, with 58.8% (76,482) being male and 41.2% (53,611) female. A one-standard-deviation (SD) increase in ozone was associated with an 8.3% increase (95% CI: 3.8%, 13.0%) in AC outpatient visits. Similar positive associations were observed when adjusting for other pollutants (PM 2.5 , CO, SO 2 and NO 2) in two-pollutant and multi-pollutant models. Furthermore, the positive association remained consistent when using mixed-effects regression models or further adjusting for meteorological conditions. In addition, no effect modification of the AC-ozone association by sex, age and season was apparent. This study provides evidence supporting a positive association between short-term ozone exposure and AC risk in China. This highlights the potential value of mitigating ozone pollution to reduce the risk of ocular surface disorders. [Display omitted] • Short-term ozone exposure linked to higher risk of AC in China. • One SD increase in ozone associated with 8.3% rise in AC outpatient visits. • No significant differences observed in AC-ozone association by sex, age, or season. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: First-line immune checkpoint inhibitor (ICI) monotherapy for advanced non–small cell lung cancer (NSCLC) was introduced in Japan in February 2017. Limited information is available since that time regarding health care resource use for NSCLC in Japan, where the hospitalization burden is high. Objective: We evaluated health care resource use from first- through third-line systemic anticancer therapy for patients with advanced NSCLC included in a multicenter, retrospective chart review study. Methods: Eligible patients were aged 20 years or older with unresectable locally advanced/metastatic NSCLC with no known actionable genomic alteration who initiated first-line systemic anticancer therapy from July 1, 2017, to December 20, 2018, at 23 Japanese hospitals. We calculated the percentage of patients with a record of each resource used, the total number of each resource, and the resource use per 100 patient-weeks of follow-up from initiation of first-, second-, and third-line therapy, overall and by the 3 most common regimen categories, namely, ICI monotherapy, platinum-doublet chemotherapy (without concomitant ICI), and nonplatinum cytotoxic regimens (nonplatinum). Study follow-up ended September 30, 2019. Results: Among 1208 patients (median age = 70 years; 975 [81%] men), 463 patients (38%) received ICI monotherapy, 647 (54%) received platinum-doublet chemotherapy, and 98 (8%) received nonplatinum regimens as first-line therapy. During the study, 621 (51%) patients initiated second-line, and 281 (23%) initiated third-line therapy. The majority of patients experienced ≥1 hospitalization (76%–94%) and ≥1 outpatient visit (85%–90%) during each therapy line. The number of hospitalizations increased from 6.5 per 100 patient-weeks in first-line to 8.0 per 100 patient-weeks in third-line. During first-line therapy, the number of hospitalizations per 100 patient-weeks were 4.8, 8.4, and 6.5 for patients receiving ICI monotherapy, platinum-doublet chemotherapy, and nonplatinum regimens, respectively, and the percentages of hospitalizations categorized as attributable to NSCLC treatment administration (no surgery, procedure, treatment of metastasis, or palliative lung radiation) were 64%, 77%, and 73%, respectively. The number of outpatient visits increased from 43.0 per 100 patient-weeks in first-line to 51.4 per 100 patient-weeks in third-line therapy. During first-line therapy, outpatient visits per 100 patient-weeks were 41.0, 46.7, and 33.0 for patients receiving ICI monotherapy, platinum-doublet chemotherapy, and nonplatinum regimens, respectively, and the percentages of outpatient visits for infusion therapy were 48%, 34%, and 36%, respectively. Conclusions: The results of this study, although solely descriptive, showed differing patterns of health care resource use during first-line therapy among the 3 common systemic anticancer therapy regimens for advanced NSCLC in Japan and suggest that further research is needed to investigate these apparent differences by treatment regimen.

Objective: To assess the quantitative association between short-term exposure to air pollution and respiratory disease outpatient visits among children in China. Methods: We searched articles from 1 January 2000 to 31 December 2020 in six peer-reviewed literature databases following PRISMA guidelines. Results: Of 2668 records, 33 were included in meta-analysis. The pooled excess risks of respiratory disease outpatient visits among children in China per 10 μg/m3 increase were 0.75% (95% CI: 0.54%, 0.96%) for PM2.5, 0.70% (95% CI: 0.50%, 0.89%) for PM10, 0.82% (95% CI: 0.58%, 1.05%) for SO2, 1.61% (95% CI: 1.25%, 1.98%) for NO2 and 0.74% (95% CI: 0.01%, 1.46%) for O3. In subgroup analysis, air pollution had a greater impact in southern or central cities, cold seasons, and areas with high relative humidity. Conclusions: Short-term exposure to air pollution was significantly associated with an increased excess risk of respiratory disease outpatient visits among children in China. [ABSTRACT FROM AUTHOR]

Purpose: A treatment gap exists in vertebral fracture (VF) patients. An outpatient visit is a necessary step to initiate treatment. The study aimed to evaluate factors associated with an outpatient visit following a VF diagnosis, and the association between the interval of an outpatient visit after VF diagnosis and its impact on prescribing of anti-osteoporosis medications (AOMs). Methods: Subjects 65 years and older from Tianliao Township in Taiwan with newly diagnosed VF between 2009 and 2010 were included. Information about outpatient visits and AOMs prescriptions were derived from the National Health Insurance Research database and followed up for 2 years. Factors associated with outpatient visits and the initiation of AOMs were assessed using the multivariable Cox proportional regression model analysis. The receiver operating characteristic curve (ROC curve) was analyzed to determine the predictive effects of the interval between an outpatient visit following the diagnosis of a new VF on initiating AOMs and the potential optimal cutoff point. Results: Of 393 participants, 42.2% had outpatient visits within 2 years after a new VF diagnosis, for which the mean interval was 4.8 ± 4.8 months. Patients who were female and reported a current use of supplements were positively associated with visits after a new VF diagnosis, but the bone mineral density (BMD) T-score was negatively associated with visits. Furthermore, 140 (35.6%) patients had initiated AOMs within 2 years after the diagnosis of a new VF. It was found that a higher BMD T-score and a longer interval between an outpatient visit following diagnosis was negatively associated with initiation of AOMs. The ROC curve analysis showed outpatient visits within 3 months after a VF diagnosis had the highest Youden index and maximum area under the curve. Conclusions: Patients who were female, were currently taking supplements, and those who had a lower BMD T-score were more likely to visit doctors after being diagnosed with a new VF. Furthermore, a lower BMD T-score and a shorter interval, within 3 months and not more than 8 months, between an outpatient visit following the diagnosis of VF increased the likelihood of being prescribed AOMs. [ABSTRACT FROM AUTHOR]

Background: Non-optimum weather conditions and air pollution have the potential to increase the risk of atopic dermatitis (AD), but the associations are rarely evaluated, especially in developing countries. Objective: To investigate the independent influence and interaction effects of meteorological factors and air pollutants on the onset of AD. Methods: Daily data on outpatient visits of AD were obtained from Shanghai Dermatology Hospital and comprised 34,633 patients during the period from January 2013 to December 2018. Meteorological conditions and air pollutant concentrations in Shanghai, China, during the 6-year period were collected. We applied the overdispersed generalized additive model and the distributed lag model to explore the short-term cumulative effects of environmental factors on AD. Results: AD symptoms were aggravated by extreme low temperature (1st percentile, 0.5°C) (RR = 1.32, 95% CI: 1.16–1.51) and per 10 unit decrease of humidity (RR = 1.10, 95% CI: 1.12–2.47). The increased concentration of air pollutants except ozone (O3) contributed to the increased risk of AD outpatients. A 10 μg/m3 increase in sulfur dioxide (SO2) and nitrogen dioxide (NO2) were associated with 6.03% (95% CI: 2.29%, 9.91%), and 1.96% (95% CI: 0.46%, 3.48%) increase of AD outpatients. AD patients in the 8- to 17-year-old group were most susceptible to extreme low temperature, and patients in the 0- to 7-year-old group were most susceptible to air pollutants, including particulate matter (PM10), SO2, and NO2. Men were more sensitive to the effects of extreme low temperature than women, while women were more vulnerable to air pollutants. The adverse effects of SO2 and NO2 on AD can be enhanced significantly by the warm season or other pollutants. Conclusion: Exposure to a lower temperature, lower humidity, and higher levels of air pollutants is significantly associated with increased risks of AD incidence. These impacts were more pronounced in children less than 7 years old, women, and warm seasons. [ABSTRACT FROM AUTHOR]

The evidence on associations between ambient gaseous pollutants and conjunctivitis remains inconclusive, and limited research is available, particularly regarding children. Based on a case-crossover study conducted in ten Chinese cities from 2013 to 2023, we documented 418,027 outpatient visits for conjunctivitis in children. Of these visits, 256,525 were for boys and 161,502 for girls. A one standard deviation (SD) increase in daily concentrations of carbon monoxide (CO) was related to a 1.20 % rise in same-day outpatient visits for pediatric conjunctivitis (OR = 1.012, 95 % CI: 1.005, 1.018). Similar associations were found for nitrogen dioxide (NO 2 : 2.90 % increase; OR = 1.029, 95 % CI: 1.019, 1.040), sulfur dioxide (SO 2 : 1.70 % increase; OR = 1.017, 95 % CI: 1.007, 1.028), and ozone (O 3 : 1.30 % increase; OR = 1.013, 95 % CI: 1.006, 1.021). The positive associations remained significant in two-pollutant and mixed-effects models. Notably, we observed stronger associations in girls compared to boys, among children at 1-5 years of age compared to other age groups, and the relationships were more pronounced during the summer months. This study reveals a link between exposure to common gaseous air pollutants and increased risks of conjunctivitis in children, indicating the potential benefits of public health interventions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: To investigate the demographic characteristics, seasonal variations, effects associated with air pollution, and geographic morbidity of asthma in Songkhla. Material and Methods: This research conducted a time series analysis of secondary data from 1 January, 2013 to 31 December, 2017. The distributed lag non-linear model was employed to analyze associations between air pollutants and daily asthma outpatient visits, and the Bayesian hierarchical modelling was used to map asthma morbidity spatiotemporally. Results: A total of 250,127 asthma diagnoses corresponding to 36,761 patients were found in the medical records. Most asthma outpatients were female (61.1%); males (1-5 years) constituted the majority of individuals during the first peak, while females (40-50 years) predominated the second peak. The trend analysis revealed a seasonal variation in the number of asthma outpatient visits; the highest rates were during the June-December period. The regression coefficient analysis revealed carbon monoxide (CO), nitrogen dioxide (NO2 ), relative humidity, and visibility to have the most significant positive effect on asthma, while the cos (wind direction) had the highest negative effect/impact. Significant associations were found between outpatient gender and age and CO, NO2 , sulfur dioxide, ozone, and particulate matter less than 10 micron. The Hat Yai and Central districts of Songkhla province were identified as morbidity hotspots. Conclusion: The number of asthma-related outpatient visits increased during the rainy season. Asthma affected primarily young boys and middle-aged women in this province, and they constitute the most sensitive group to air pollutants such as CO and NO2 and meteorological conditions like relative humidity and visibility. The highest morbidity rates were found in urbanized habitats.

Abstract Background The prevalence of allergic diseases (ADs), such as asthma and allergic rhinitis (AR), is increasing worldwide in both adults and children. Although ADs are common and frequently coexist in outpatient care, city-level data regarding the characteristics of childhood AD remain limited in China. This study aimed to assess the profile and characteristics of ADs in the city of Shanghai. Methods A multicenter retrospective study was designed to collect routine administrative data from outpatient and emergency departments from 66 hospitals in Shanghai, China, from 2016 to 2018. Children with asthma, AR, allergic conjunctivitis (AC), and allergic skin diseases were investigated. Demographic characteristics, patients visit pattern, spectrum of diagnosis, and comorbidities were analyzed. Results A total of 2,376,150 outpatient and emergency visits for ADs were included in the period from 2016 to 2018. Allergic skin diseases accounted for 38.9%, followed by asthma (34.8%), AR (22.9%), and AC (3.3%), with a male predominance in all four diseases. Asthma and allergic skin diseases were most frequent in the 1 to

Introduction: Patients with primary Sjögren's syndrome (pSS) reportedly believe that their symptoms worsen on extreme weather days due to variations in environmental conditions. However, few studies have assessed the acute effects of environmental exposure on the onset of pSS. This study aimed to evaluate the exposure–response relationship between extreme environmental conditions and pSS outpatient visits. Method: We obtained data on pSS outpatient visits from two provincial general hospitals in Hefei, China, during 2014–2019. A distributed lag non-linear model was used to estimate the exposure-lag-response relationship between environmental variables and pSS. Results: We detected significant and non-linear associations between extreme environments and pSS. The estimated relative risk (RR) for a lag of 3 days was 1.11 (95% CI: 1.03 to 1.19) for extreme cold and for a lag of 21 days was 1.07 (95% CI: 1.01 to 1.12) for extreme dampness. Long sunshine duration was positively correlated with pSS (lag 11, 1.05, 95% CI: 1.01 to 1.08). Moreover, female patients were more susceptible to these effects. Patients older than 65 years old were more vulnerable to frigid environments (lag 3, RR = 1.30, 95% CI: 1.09 to 1.54), while younger patients were more vulnerable to extreme dampness (lag 21, RR = 1.10, 95% CI: 1.03 to 1.16). Extreme cold and high humidity were negatively correlated with the same-day outpatient visits. Conclusions: Our findings suggest a potential relationship between exposure to extreme environmental conditions and increased risk of pSS outpatient visits. We therefore suggest that policymakers and doctors aim to further our understanding of environmental effects on pSS and adopt adequate measures to alleviate pSS symptoms. Key Points • Extreme cold, extreme dampness, and long sunshine duration increased the risk of pSS outpatient visits, especially for females. • Young pSS patients are more susceptible to a rise in humidity. • Elderly pSS patients are more sensitive to extreme cold weather. [ABSTRACT FROM AUTHOR]

Abstract Background A great number of studies have confirmed that children are a particularly vulnerable population to air pollution. Methods In the present study, 332,337 outpatient visits of 15 hospitals for respiratory diseases among children (0–13 years), as well as the simultaneous meteorological and air pollution data, were obtained from 2014 to 2016 in Lanzhou, China. The generalized additive model was used to examine the effects of air pollutants on children’s respiratory outpatient visits, including the stratified analysis of age, gender and season. Results We found that PM2.5, NO2 and SO2 were significantly associated with the increased total respiratory outpatient visits. The increments of total respiratory outpatient visits were the highest in lag 05 for NO2 and SO2, a 10 μg/m3 increase in NO2 and SO2 was associated with a 2.50% (95% CI: 1.54, 3.48%) and 3.50% (95% CI: 1.51, 5.53%) increase in total respiratory outpatient visits, respectively. Those associations remained stable in two-pollutant models. Through stratification analysis, all air pollutants other than PM10 were significantly positive associated with the outpatients of bronchitis and upper respiratory tract infection. Besides, both NO2 and SO2 were positively related to the pneumonia outpatient visits. PM2.5 and SO2 were significantly related to the outpatient visits of other respiratory diseases, while only NO2 was positively associated with the asthma outpatients. We found these associations were stronger in girls than in boys, particularly in younger (0–3 years) children. Interestingly, season stratification analysis indicated that these associations were stronger in the cold season than in the transition or the hot season for PM10, PM2.5 and SO2. Conclusions Our results indicate that the air pollution exposure may account for the increased risk of outpatient visits for respiratory diseases among children in Lanzhou, particularly for younger children and in the cold season.

Background: Due to the increasing burden on the heatlhcare system the usefulness of the routinely planned 6-week outpatient visit and radiograph in patients treated surgically for the most common upper extremity fractures, including clavicle, proximal humerus, humeral shaft, olecranon, radial shaft, and distal radius, should be investigated., Method: This was a retrospective cohort study of all patients treated surgically for the most common upper extremity fractures between 2019 and 2022 in a level 1 trauma center. The first outcome of interest was the incidence of abnormalities found on the radiograph taken at the 6-week outpatient visit. Abnormalities were defined as all differences between the intraoperative (or direct postoperative) and 6-week radiograph. In case an abnormality was detected, the hospital records were screened to determine its clinical consequence. The clinical consequences were categorized into requiring either additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing, or allowed range of motion (ROM). The second outcome of interest was the incidence of deviations from the local standard postoperative treatment and follow-up protocol based on the 6-week outpatient visit as a whole. Deviations were also categorized into either requiring additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing, or allowed ROM., Results: A total of 267 patients were included. Abnormalities on radiograph at 6 weeks postoperatively were found in only 10 (3.7%) patients, of which only 4 (1.5%) had clinical implications (in 3 patients extra imaging was required and in 1 patient it was necessary to deviate from standard weightbearing/ROM limitation regimen). The clinical/radiologic findings during the 6-week outpatient visit led to a deviation from standard in only 8 (3.0%) patients. Notably, the majority of these patients experienced symptoms suggestive of complications., Conclusion: The routine 6-week outpatient visit and radiograph, after surgery for common upper extremity fractures, rarely has clinical consequences. It should be questioned whether these routine visits are necessary and whether a more selective approach should be considered., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Previous studies, mostly analyzing data from high‐income economies, present mixed evidence on the relationship between retirement and healthcare utilization. This study leverages administrative data for over 80,000 urban Chinese workers to explore the effect of retirement on outpatient and inpatient care utilization using a fuzzy regression discontinuity design. The analyses of medical claims from a large city in China complement and extend the current literature by providing evidence of potential mechanisms underlying increased short‐run utilization. In this relatively well‐insured population, annual total healthcare expenditures significantly increase primarily because of more intensive use of outpatient care at retirement, especially at the right tail of the distribution of outpatient visits. This increase in outpatient care appears to stem from a decline in the patient cost‐sharing rate and the reduced opportunity cost of time upon retirement, interacting with supplier‐induced demand, not from any sudden impact on health. We do not find evidence of change in inpatient care at retirement. The results hold for both females and males, and are robust to a number of sensitivity analyses. [ABSTRACT FROM AUTHOR]

Background: The prevalence of allergic diseases (ADs), such as asthma and allergic rhinitis (AR), is increasing worldwide in both adults and children. Although ADs are common and frequently coexist in outpatient care, city-level data regarding the characteristics of childhood AD remain limited in China. This study aimed to assess the profile and characteristics of ADs in the city of Shanghai.Methods: A multicenter retrospective study was designed to collect routine administrative data from outpatient and emergency departments from 66 hospitals in Shanghai, China, from 2016 to 2018. Children with asthma, AR, allergic conjunctivitis (AC), and allergic skin diseases were investigated. Demographic characteristics, patients visit pattern, spectrum of diagnosis, and comorbidities were analyzed.Results: A total of 2,376,150 outpatient and emergency visits for ADs were included in the period from 2016 to 2018. Allergic skin diseases accounted for 38.9%, followed by asthma (34.8%), AR (22.9%), and AC (3.3%), with a male predominance in all four diseases. Asthma and allergic skin diseases were most frequent in the 1 to < 4 years of age group, while AR and AC were more common in the 4 to < 7 years of age group. Asthma accounted for the greatest number of annual and emergency visits. The most frequent comorbidity of asthma was lower respiratory tract infection (LRTI) (49.3%), followed by AR (20.5%) and upper respiratory tract infection (14.1%). The most common comorbidities of AR were otitis media (23.4%), adenoid hypertrophy/obstructive sleep apnea (22.1%), followed by LRTI (12.1%), asthma (9.4%) and chronic pharyngitis (8.9%).Conclusions: Asthma and allergic skin diseases were the most common ADs in outpatient and emergency departments in the study period. Respiratory tract infection was the most common comorbidity of asthma in children. More attention should be devoted to the treatment of comorbidities to improve childhood AD outcomes with a better understanding of the characteristics of ADs in outpatient care. [ABSTRACT FROM AUTHOR]

Background: There has been a recent worsening of air pollution in China, which poses a huge threat to public health by inducing and promoting circulatory and respiratory diseases. This study aimed to explore the association between the concentration of air pollution and daily internal medicine outpatient visits registered for the treatment of circulatory and respiratory symptoms in Zhoushan, China using a time-series method.Methods: We validated and acquired the daily internal medicine outpatient visits records between January 1, 2014, and December 31, 2019, from the Zhoushan Center for Disease Control and Prevention in Zhejiang, China. Further, we collected the daily average records of the ambient air pollutants from the Zhoushan Environmental Monitoring Centre within the same duration. A generalized additive model with the natural splines was constructed to explore the association between the ambient air pollutants and daily internal medicine outpatient visits. Further, we conducted a lag analysis by using the distributed lag non-linear model to estimate the time-delayed effects of the air pollutants on the daily internal medicine outpatient visits.Results: A total of 2,190,258 daily internal medicine outpatient visits with a mean of 202.4 visits per day were recorded. The non-linear relationships were found among particulate matter2.5 (PM2.5), sulfur dioxide (SO2), and the daily internal medicine outpatient visits. Overall, PM2.5 was positively correlated with the daily internal medicine outpatient visits. Both ozone (O3) and SO2 had significant delayed effects on the daily internal medical outpatient numbers; however, PM2.5 only showed a short-term risk.Conclusion: Short-term exposure to PM2.5 was associated with an increase in the daily internal medicine outpatient visits for circulatory and respiratory diseases/symptoms in Zhoushan, China. SO2 and O3 were shown to induce significant effects after a concentration-dependent time lag.

Background: In Indonesia, the referrals to hospitals by Primary Care Providers (PCPs) is high. In 2018, more than 15 per cent of patients visiting PCPs were referred to hospitals, while the cost for outpatient visits reached 51.2 trillion rupiahs. As of September 2019, Indonesia’s Body of Social Security for Health of Indonesia (BPJS Kesehatan) enacted a horizontal referral policy. PCPs will refer patients to other PCPs with more resourced facilities. Objectives: To assess the impact of horizontal referral on hospital outpatient visits and how cost savings were made. Methods: This study is a non-experimental big-data analysis by observational descriptive method. Results: Data results were classified into two groups in order to separate data analysis affected by external COVID-19 pandemic factors. Group I consisted of data from September to December 2019 and group II consisted of data from January 2020 to October 2020. In data Group I, a total of 8.140 cases were referred horizontally and not referred to hospitals. Referral ratio decreased from 16,50% prior the policy enactment to 15,71% in December 2019. In data Group II, horizontal referral showed an increasing trend from January to October 2020 with 56.875 total cases being referred among primary care providers. Cost savings from September 2019 to October 2020 reached 25.891.347.236 rupiahs. Conclusions: The horizontal referral policy in Indonesia reduced the number of patients referred to hospitals, hence creating cost savings. It proposes collaboration among primary care providers, thus controlling unnecessary referrals to hospitals.

Little is known about the influence of ambient fine particulate matter (PM2.5) on the incidence of venous thromboembolism in areas with heavy air pollution. We examined seasonal associations between airborne concentrations of fine particulate matter and outpatient visits for venous thromboembolism in Beijing using a city-wide time-series design that covered a period of 30 months (January 1, 2010 to June 30, 2012). Generalized additive models were used to investigate the associations with adjustment of temperature for various time lags (lag 0 for the warm season and lag 0–10 for the cold season). Overall, 92,435 outpatient visits were recorded by the Beijing Medical Claim Data for Employees database during the study period. We found a significant association between PM2.5 levels and outpatient visits for venous thromboembolism. A 10-μg/m3 increase in PM2.5 concentrations on lag days 0–2 corresponded to a 0.64% (95% confidence interval: 0.55–0.73%; P < 0.001) increase in outpatient visits for venous thromboembolism during the cold season, and a 10-μg/m3 increase in PM2.5 concentrations on lag days 0–3 corresponded to a 0.82% (95% confidence interval: 0.67–0.96%; P < 0.001) increase in outpatient visits for venous thromboembolism during the warm season. Our findings suggest that PM2.5 exposure is associated with outpatient visits for venous thromboembolism in Beijing, and a more pronounced association was observed during the warm season. We propose that various temperature-adjustment strategies should be used when investigating seasonal associations. [ABSTRACT FROM AUTHOR]

Abstract Background The eastern and western regions of China are different in many ways such as socioeconomic characteristics and health resource distribution. This study aimed to explore the outpatient health-seeking behavior and compare the influencing factors of residents in Zhejiang and Qinghai Province, which represent the situation in eastern and western China. Thus, this research will provide evidence for health resource allocation and health reform. Methods A cross-sectional study was conducted on a sample selected from 1600 households in Zhejiang and Qinghai province between 2016 to 2017 by the multi-stage stratified cluster random sampling method. Among the 4231 residents aged 15 years or older in the sample, 566 who reported ill-health were selected for data analysis. Two-week outpatient visits and choice of health institutions were used to measure residents’ outpatient health-seeking behavior and assessed using Chi-square tests. The binary logistic regression was adopted to demonstrate the association between explanatory variables and outpatient visits. Results The study revealed that out of the people who reported ill-health, 58 individuals (50.97%) in Zhejiang and 106 (41.41%) in Qinghai went to health institutions to seek medical help (p 0.05). Among these respondents, Self-report severity was the common and significant factor related to their outpatient visits and it had a greater impact on outpatient visits in Zhejiang (4.18, CI 2.23–7.83, p

Abstract Background Previous studies showed inconsistent results on risk of increased outpatient visits for cause-specific diseases associated with ambient carbon monoxide (CO). Methods Daily data for CO exposure and outpatient visits for all-causes and five specific diseases in Yichang, China from 1st January 2016 to 31st December 2017 were collected. Generalised additive models with different lag structures were used to examine the short-term effects of ambient CO on outpatient visits. Potential effect modifications by age, sex and season were examined. Results A total of 5,408,021 outpatient visits were recorded. We found positive and statistically significant associations between CO and outpatient visits for multiple outcomes and all the estimated risks increased with longer moving average lags. An increase of 1 mg/m3 of CO at lag06 (a moving average of lag0 to lag6), was associated with 24.67% (95%CI: 14.48, 34.85%), 21.79% (95%CI: 12.24, 31.35%), 39.30% (95%CI: 25.67, 52.92%), 25.83% (95%CI: 13.91, 37.74%) and 19.04% (95%CI: 8.39, 29.68%) increase in daily outpatient visits for all-cause, respiratory, cardiovascular, genitourinary and gastrointestinal diseases respectively. The associations for all disease categories except for genitourinary diseases were statistically significant and stronger in warm seasons than cool seasons. Conclusion Our analyses provide evidences that the CO increased the total and cause-specific outpatient visits and strengthen the rationale for further reduction of CO pollution levels in Yichang. Ambient CO exerted adverse effect on respiratory, cardiovascular, genitourinary, gastrointestinal and neuropsychiatric diseases especially in the warm seasons.

Abstract Background Little is known about the effect of ambient fine particulate matter (PM2.5) on chronic obstructive pulmonary disease (COPD) in China. The objective of this study was to explore the short-term effects of PM2.5 on outpatient and inpatient visits for COPD in Beijing, China. Methods A total of 3,503,313 outpatient visits and 126,982 inpatient visits for COPD between January 1, 2010, and June 30, 2012, were identified from the Beijing Medical Claim Data for Employees. A generalized additive Poisson model was applied to estimate the percentage change with 95% confidence interval (CI) in hospital visits for COPD in relation to an interquartile range (IQR) (90.8 μg/m3) increase in PM2.5 concentrations. Results Short-term exposure to PM2.5 was significantly associated with increased use of COPD-related health services. There were clear exposure–response associations of PM2.5 with COPD outpatient and inpatient visits. An IQR increase in the concurrent day PM2.5 concentrations was significantly associated with a 2.38% (95% CI, 2.22%–2.53%) and 6.03% (95% CI, 5.19%–6.87%) increase in daily outpatient visits and inpatient visits, respectively. Elderly people were more sensitive to the adverse effects. The estimated risk was higher during the warm season compared to the cool season. Conclusions Short-term exposure to PM2.5 was associated with increased risk of hospital visits for COPD. Our findings contributed to the limited evidence concerning the effects of ambient PM2.5 on COPD morbidity in developing countries.

We aimed to quantify the relationship between the outpatient visits of hand, foot, and mouth disease (HFMD) and diurnal temperature range (DTR). The data of daily HFMD outpatient visits and meteorological parameters were obtained. A distributed lag nonlinear model combined with generalized linear model was used to estimate simultaneously nonlinear and delayed effects between DTR and daily HFMD outpatient visits after controlling confounding factors. A total of 15,275 HFMD visits were enrolled. DTR was significantly associated with HFMD outpatient visits in children. High DTR (P75: 11.4 °C) and extreme DTR (P95: 15.3 °C) were compared with 8.5 °C, and HFMD visits increased by a maximum of 3.93% (95% CI: 1.82 to 6.07%) and 4.47% (95% CI: 0.45 to 8.65%) in single-day lag effect, respectively. Furthermore, the extreme DTR effect decreased with the lag time and lasted for 10 days. Cumulative lag effects with markedly increasing percent of visits are over 64.88%. Furthermore, the effects were most pronounced among female children and children aged 0–2 years. Our study suggested that DTR changes were associated with HFMD outpatient visits, and populations of female and aged 0–2 years were more sensitive. [ABSTRACT FROM AUTHOR]

Background: A great number of studies have confirmed that children are a particularly vulnerable population to air pollution.Methods: In the present study, 332,337 outpatient visits of 15 hospitals for respiratory diseases among children (0-13 years), as well as the simultaneous meteorological and air pollution data, were obtained from 2014 to 2016 in Lanzhou, China. The generalized additive model was used to examine the effects of air pollutants on children's respiratory outpatient visits, including the stratified analysis of age, gender and season.Results: We found that PM2.5, NO2 and SO2 were significantly associated with the increased total respiratory outpatient visits. The increments of total respiratory outpatient visits were the highest in lag 05 for NO2 and SO2, a 10 μg/m3 increase in NO2 and SO2 was associated with a 2.50% (95% CI: 1.54, 3.48%) and 3.50% (95% CI: 1.51, 5.53%) increase in total respiratory outpatient visits, respectively. Those associations remained stable in two-pollutant models. Through stratification analysis, all air pollutants other than PM10 were significantly positive associated with the outpatients of bronchitis and upper respiratory tract infection. Besides, both NO2 and SO2 were positively related to the pneumonia outpatient visits. PM2.5 and SO2 were significantly related to the outpatient visits of other respiratory diseases, while only NO2 was positively associated with the asthma outpatients. We found these associations were stronger in girls than in boys, particularly in younger (0-3 years) children. Interestingly, season stratification analysis indicated that these associations were stronger in the cold season than in the transition or the hot season for PM10, PM2.5 and SO2.Conclusions: Our results indicate that the air pollution exposure may account for the increased risk of outpatient visits for respiratory diseases among children in Lanzhou, particularly for younger children and in the cold season. [ABSTRACT FROM AUTHOR]

Objective (s): Satisfaction of medical services has been considered as one of the most important outcomes.. In Iran veterans and their families are covered by supplementary health insurance. The aim of this study was to assess the satisfaction of veterans and their families with outpatient care. Methods: This was a cross-sectional study A random sample of 1224 veterans and their families who attended outpatient care were studied. The trained interviewers collected the data through telephone interviews. Descriptive and analytical statistics were performed too analyze the data using chi-square test and logistic regression analysis. Results: The mean age of participants was 45.7 ± 13.9 years, 67% were male and 85% were living in urban areas. In outpatient visits, the satisfaction with the services was 94%. Satisfaction with the distant from service delivery location was 83 % and with the process of refunding the costs was 42%. Veteran groups and place of living were the important factors that were related to the satisfaction with the distant from service delivery location. Conclusion: The results indicated that care receivers were satisfied with the service of outpatient visit. Comparing to the desirable satisfaction with the service outpatient visit, satisfaction with the distant from service delivery location and the process of refunding the costs were lower and should be improved.

Abstract Background The Korean healthcare system is composed of costly and inefficient structures that fail to adequately divide the functions and roles of medical care organizations. To resolve this matter, the government reformed the cost-sharing policy in November of 2011 for the management of outpatients visiting general or tertiary hospitals with comparatively mild diseases. The purpose of the present study was to examine the impact of increasing the coinsurance rate of prescription drug costs for 52 mild diseases at general or tertiary hospitals on outpatient healthcare service utilization. Methods The present study used health insurance claim data collected from 2010 to 2013. The study population consisted of 505,691 outpatients and was defined as those aged 20–64 years who had visited medical care organizations for the treatment of 52 diseases both before and after the program began. To examine the effect of the cost-sharing policy on outpatient healthcare service utilization (percentage of general or tertiary hospital utilization, number of outpatient visits, and outpatient medical costs), a segmented regression analysis was performed. Results After the policy to increase the coinsurance rate on prescription drug costs was implemented, the number of outpatient visits at general or tertiary hospitals decreased (β = −0.0114, p

Patient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first. Despite the expansion in the number of health facilities, it has been seen when patients routinely accessed referral hospitals without a formal referral. The study aims to evaluate cost of treatment among self-referred outpatients at referral hospitals compared to primary health care facilities. Comparative cross-sectional study design was used and the required sample size for the study was determined by using formula of double populations mean comparison cost of treatment for diseases leading to outpatient visits. A total of 794 participants (397 from referral hospital and 397 from primary health facilities) were included in the study. Data was collected using face-to-face interview from December 1 to 30, 2017. Data entry and analysis were made using SPSS version 20. Descriptive statistics and independent samples t-test were performed. A total of 783 outpatients responded to the interview of the study and 391 of them were from referral hospital and 392 from primary health facilities. The mean of outpatient visit cost per visit for the treatment of diseases leading to outpatient visits was significantly higher at referral hospitals compared to primary health facilities [95% CI=6.13 (5.07-7.18)] USD. The mean cost of outpatient visits for the treatment of all type of diseases leading to outpatient visits was significantly higher at referral hospitals and at least two times of primary level health facilities. Health care providers should create awareness in the community about referral linkages to inform patients and their families the additional costs they incur when they bypass the proximal primary health facilities.

Context: Postmarket surveillance is limited in the ability to detect medical device problems. Electronic health records can provide real-time information that might help with device surveillance. Specifically, the frequency of postsurgery care might indicate early problems and determine high-risk patients requiring more active surveillance. Objective: To evaluate whether intensity of postsurgery care is associated with revision risk after total joint arthroplasty (TJA). Design: Using an integrated health care system's TJA registry, we identified primary TJA performed between April 2001 and July 2013 (22,953 knees and 9904 hips). Survival analyses evaluated the frequency of specific types of outpatient and inpatient utilization 0 to 90 and 91 to 180 days postoperatively and revision risk. Main Outcome Measures: Revision surgery occurring at least 6 months after primary TJA. Results: Knee arthroplasty recipients with 3 or more outpatient orthopedic allied health/nurse visits within 90 days had a 2.2 times (95% confidence interval [CI] = 1.6-2.9) higher risk of revision within the first 2 years postoperatively and 10.1 times higher risk (95% CI = 7.6-13.3) after 2 years. Compared with hip arthroplasty recipients who had 0 to 3 visits, patients with 6 or more outpatient orthopedic office visits within 90 days had a 15.7 times (95% CI = 5.7-42.9) higher risk of revision. Similar results were observed for 91-day to 180-day visits. Conclusion: Future studies are needed to determine if more specific data on reasons for the higher frequency of outpatient visits can refine these findings and elicit more specific recommendations for TJA devices. [ABSTRACT FROM AUTHOR]

Objectives: Inflammatory bowel disease (IBD) is associated with a high economic burden to society due to its early onset and chronic character. Here, we set out to characterize healthcare resource utilization and associated costs in Crohn's disease (CD) and ulcerative colitis (UC) patients with infliximab treatment, the most widely used first-line biologic agent in Finland, in a real-world clinical setting. Methods: This was a retrospective, non-interventional single-center study. Infliximab was administered in routine care, and data were collected retrospectively from electronic health records. All adult anti-TNF naïve CD or UC patients whose infliximab treatment was initiated at the Hospital District of Southwest Finland between the years of 2014 and 2016 were included in the study. Each patient was followed-up for 12 months after the initiation of infliximab treatment. Results: A total of 155 patients were included (45 CD, 110 UC). Altogether, 60.0% (n = 27) of all CD patients and 43.6% (n = 48) of all UC patients persisted on infliximab therapy 12 months after treatment initiation. The total cost was similar for both CD and UC cohorts (CD, €10,243; UC, €10,770), infliximab treatment being the highest individual cost (60.3% of the total cost in CD; 53.4% in UC). The mean number of infliximab infusions during the 12-month follow-up was 7.0 for CD and 6.5 for UC patients. Conclusions: IBD causes a significant burden to the Finnish healthcare system. This study provides a detailed characterization of the cost landscape of IBD and contributes to optimizing treatment strategies and healthcare resource use in the biosimilar era. [ABSTRACT FROM AUTHOR]

Abstract Objectives This study aims to estimate the impact of heatwaves from July 2010 to October 2012 on daily outpatient visits for respiratory disease (RD) in Cangnan, China and identify vulnerable populations. Methods The definition of heatwave was a period at least 3 consecutive days with maximum temperature exceeding 35 °C in this study. A time-stratified case-crossover design was conducted to examine the relationship between heatwaves and outpatient visits for RD. Patient data for the period from 2010 to 2012 were collected from the Third People's Hospital of Cangnan and daily meteorological data for the same period were collected from the China Meteorological Data Service Center. Data regarding the air pollution index (API), a composite indicator of air pollution, were collected from the Data Center of the Chinese Ministry of Environmental Protection. RD were identified based on the 10th revision International Classification of Diseases (ICD-10) codes (J00-J99). A conditional Poisson regression model was applied to examine the heatwave-RD association using the Relative Risk (RR) while adjusting for meteorological and air pollution factors including temperature, rainfall, wind speed, pressure, humidity, sunshine hours and API. Results During the study period, 4 heatwaves occurred and a total of 1732 outpatient visits for RD were reported. Heatwaves increased the frequency of RD outpatient visits and the highest RR of total RD was 1.155% and 95% Confidence Intervals (95% CI) was 1.084–1.232 at Lag 0. For subcategories, heatwaves increased the risk of infectious RD (Lag 0: RR =1.182, 95% CI : 1.106–1.263) and decreased the risk of non-infectious RD ((Lag 6: RR =0.750, 95% CI : 0.568–0.990). Moreover, heatwaves showed adverse effects on acute upper respiratory infection (Lag 0: RR =1.306, 95% CI : 1.177–1.450). The RR of outpatient visits for RD was statistically significant in females (Lag 0: RR =1.161, 95% CI : 1.046–1.298), males (Lag 4: RR =1.161, 95% CI : 1.096–1.261), young people aged 4–17 years (Lag 0: RR =1.741, 95% CI : 1.524–1.990) and elders aged 65 years or older (Lag 5: RR =1.412, 95% CI : 1.111–1.794) during heatwaves. Conclusions Heatwaves had a significant harmful impact on daily outpatient visits for RD in Cangnan, especially for vulnerable population identified. These results can be used not only to strengthen the health education and protection of these vulnerable populations, but also to assist relevant organizations with developing intervention programmes and improving disease prevention and community care. Highlights • Heatwaves significantly increased outpatient visits for respiratory disease in Cangnan, China. • Effects of heatwaves on outpatient visits varied across different subgroups for respiratory disease. • Vulnerable groups of respiratory disease during heatwaves were identified. • Confounders were controlled in the model. [ABSTRACT FROM AUTHOR]

Abstract Background Many cities in China are currently experiencing severe air pollution due to modernization. Previous studies investigating the effects of air pollutants exposure were particularly conducted in severe air polluted area and studies in low pollution areas were sparse. Methods To quantitatively assess the short-term effects of ambient air pollutants (PM 2.5 , PM 10 , SO 2 , NO 2 , CO and O 3) on outpatient visits in low pollution area, we conducted a time-series analysis from Jan 1, 2015 to Dec 31, 2016 in Shennongjia, China. Generalized additive model (GAM) was used to evaluate the influence of PM 2.5 on daily hospital outpatient visits with different lag structures. We also conducted stratified analysis to explore the association between PM 2.5 concentration and outpatient visits in different seasons. Results In the present study, per IQR increment of PM 2.5, PM 10 , NO 2 , CO and O 3 were related with 1.92% (0.76%–3.09%), 1.92% (0.77%–3.07%), 2.74% (95% CI: 1.65%–3.83%), 1.89% (95% CI: 0.68%–3.10%) and 2.30% (95% CI: 0.65%–3.95%) increase on respiratory outpatient visits. Significant associations were found between PM 2.5, PM 10 , NO 2 and respiratory outpatient visits at lag0:1, lag0:2 days. The effects of PM 2.5 were more evident in the cool season than in the warm season. Conclusions Our study showed that short-term exposures to PM 2.5, PM 10 , NO 2 , CO and O 3 were related with increased risk of outpatient visits of respiratory diseases, and highlighted the adverse effect of air pollutants exposure, especially PM 2.5 exposure in cool season on health in low pollution area. Graphical abstract Image 1 Highlights • Rare attention was paid to low pollution areas in China. • We conducted a research in Shennongjia, an area with low level air pollution in China. • Air pollutants exposure may increase the number of respiratory outpatient visits. • The prevention of low level air pollution in China is urgent and necessary. [ABSTRACT FROM AUTHOR]

Patient self-referral is a condition when patients refer themselves to higher level health facilities without having to see anyone else first. Despite the expansion in the number of health facilities, it has been seen when patients routinely accessed referral hospitals without a formal referral. The study aims to evaluate cost of treatment among self-referred outpatients at referral hospitals compared to primary health care facilities. Comparative cross-sectional study design was used and the required sample size for the study was determined by using formula of double populations mean comparison cost of treatment for diseases leading to outpatient visits. A total of 794 participants (397 from referral hospital and 397 from primary health facilities) were included in the study. Data was collected using face-to-face interview from December 1 to 30, 2017. Data entry and analysis were made using SPSS version 20. Descriptive statistics and independent samples t-test were performed. A total of 783 outpatients responded to the interview of the study and 391 of them were from referral hospital and 392 from primary health facilities. The mean of outpatient visit cost per visit for the treatment of diseases leading to outpatient visits was significantly higher at referral hospitals compared to primary health facilities [95% CI=6.13 (5.07-7.18)] USD. The mean cost of outpatient visits for the treatment of all type of diseases leading to outpatient visits was significantly higher at referral hospitals and at least two times of primary level health facilities. Health care providers should create awareness in the community about referral linkages to inform patients and their families the additional costs they incur when they bypass the proximal primary health facilities. [ABSTRACT FROM AUTHOR]

Objective: To estimate outpatient visits and hospitalization rates due to cardiopulmonary illness attributable to influenza from 2008-09 to 2012-13 in a large cohort of pregnant women from Catalonia, Spain.Methods: We estimated the event rates occurring during influenza epidemic, influenza non-epidemic and non-influenza seasons, and by pregnancy status (one year before pregnancy, first, second and third trimester). We fitted quasi-Poisson models in order to identify the variables associated to higher event rates.Results: During influenza epidemic seasons, pregnant women in their second trimester had the highest rates of outpatient visits (153 per 10,000 women-months). An increased risk of outpatient visits was associated to first or second trimester (adjusted rate ratio (aRR) = 1.17; 95% CI, 1.10-1.23 and aRR, 1.36; 95% CI, 1.28-1.43, respectively) and having any comorbidity (aRR = 1.28; 95% CI, 1.21-1.36). Women during third trimester had the highest rates of hospitalizations (1.60 per 10,000 women-months), and an increased risk of hospitalization was significantly associated to third trimester (aRR, 1.85; 95% CI, 1.01-3.39), having any comorbidity (aRR, 1.93; 95% CI, 1.10-3.41) and the pandemic influenza season (aRR, 2.90 (1.81; 95% CI, 1.81-4.64).Conclusion: Our findings provide significant information regarding influenza burden of disease among pregnant women. [ABSTRACT FROM AUTHOR]

Knowing the burden of influenza is helpful for policy decisions. Here we estimated the contribution of influenza-like illness (ILI) visits associated with laboratory-confirmed influenza among all clinic visits in a Senegal sentinel network. ILI data from ten sentinel sites were collected from January 2013 to December 2015. ILI was defined as an axillary measured fever of more than 37.5 °C with a cough or a sore throat. Collected nasopharyngeal swabs were tested for influenza viruses by rRT-PCR. Influenza-associated ILI was defined as ILI with laboratory-confirmed influenza. For the influenza disease burden estimation, we used all-case outpatient visits during the study period who sought care at selected sites. Of 4030 ILI outpatients tested, 1022 were influenza positive. The estimated proportional contribution of influenza-associated ILI was, per 100 outpatients, 1.2 (95% CI 1.1-1.3), 0.32 (95% CI 0.28-0.35), 1.11 (95% CI 1.05-1.16) during 2013, 2014, 2015, respectively. The age-specific outpatient visits proportions of influenza-associated ILI were higher among children under 5 years (0.68%, 95% CI: 0.62-0.70). The predominant virus during years 2013 and 2015 was influenza B while A/H3N2 subtype was predominant during 2014. Influenza viruses cause a substantial burden of outpatient visits particularly among children under 5 of age in Senegal and highlight the need of vaccination in risk groups. [ABSTRACT FROM AUTHOR]

Purpose: To identify how severity of depression predicts future utilization of psychiatric care and antidepressants.Methods: Data derived from a longitudinal population-based study in Stockholm, Sweden, include 10443 participants aged 20-64 years. Depression was assessed by Major Depression Inventory and divided into subsyndromal, mild, moderate and severe depression. Outcomes were the first time of hospitalization, specialized outpatient care and prescribed drugs obtained from national register records. The association between severity of depression and outcomes was tested by Cox regression analysis, after adjusting for gender, psychiatric treatment history and socio-environmental factors.Results: The cumulative incidences of hospitalizations, outpatient care and antidepressants were 4.0, 11.2, and 21.9% respectively. Compared to the non-depressed group, people with different severity of depression (subsyndromal, mild, moderate and severe depression) all had significantly higher risk of all three psychiatric services (all log-rank test P < 0.001). Use of psychiatric care and antidepressants increased by rising severity of depression. Although the associations between severity of depression and psychiatric services were significant, the dose relationship was not present in people with previous psychiatric history or after adjusting for gender and other factors.Conclusions: People with subsyndromal to severe depression all have increased future psychiatric service utilization compared to non-depressed people. [ABSTRACT FROM AUTHOR]